PROJECT 4: Measuring Adult Health in an Experimental Setting The health of older populations is affected by many factors, but understanding these factors and measuring the health consequences remains a scientific challenge. Newer survey methods and medical technologies offer the promise of being able to better assess the relative contributions of higher quality, increased access, and varying socioeconomic and demographic characteristics. The way health care services are financed and delivered is also important-many countries are looking for ways to improve services to the elderly. These efforts are complicated by the dynamic effects the policy incentives have on individual and provider behavior. In this project, we propose to use new ways to measure physiologic health and validated clinical vignettes to measure quality. This and other information will be collected in three surveys of households, facilities, and individuals using the facilities. The study builds on data collection efforts already funded in the Former Yugoslav Republic of Macedonia. Macedonia is an ideal place to study the factors that affect health status in the elderly, because after baseline data are collected, policy changes will be introduced on an experimental basis at the end of 1998. The data analysis will be done on both the Existing Household and Facility Survey (AHFES) and the Adult Household and Facility evaluation supplement (AHFES). We are proposing three general aims of analysis on the combined data sets. First, we will do a benchmark analysis. This analysis will look at population prevalence of five common diseases of the elderly, at their access to care and the quality of that care, and at how these factors and health status vary by socioeconomic and demographic characteristics. Second, we will assess the data quality of our new physiologic measures and our new quality measures. We are interested in looking at (a) comparisons between subjective and the new objective measures; (b) the ability of vignettes to measures the quality of care; and (c) how vignettes compare to measures of facility quality measurements. Third, we want to take advantages of the experimental nature of the data and look at how individual behaviors change when the economic incentives are restructured. We will evaluate the effects of the two health policy forms on the access and the quality of care the elderly receive. We will also evaluate how these impacts, together with the effects of economic, social, and demographic factors-mediate health status in the elderly.